Planning Your Homebirth: What You Should Know About Safety

The number of homebirths is increasing – have you thought through the implications of having a baby at home? Image by Decoded Pregnancy, all rights reserved.

If you value normal birth and few interventions, you’ll be happy to know of a large multi-year study that found: “No increase in adverse outcomes are associated with planned homebirth.”

The Number of Homebirths Rose a Whopping 41% Between 2004 and 2010

Although home and birth center deliveries still make up less than 1% of births in the United States, they are becoming more popular. You may be among the many mothers who want to avoid medical interventions, such as labor induction, drugs for pain, confinement to bed, uncomfortable procedures and constant monitoring.

You may choose instead to have easy access to caregivers while you are pregnant, to have the freedom to move about in labor, the consistent attendance of people who believe in your ability to give birth, and the unquestioned right to participate in all decisions.

You may expect that the care provided by homebirth midwives will lead to birthing under your own power while squatting, standing, leaning across your bed or taking a bath! You’ve given careful consideration to what you could be sacrificing to achieve your ideal birth; friends and family may wonder why you would take such a gamble.

Isn’t the Hospital the Safest Place to Give Birth?

Studies of homebirth in the Netherlands, Canada, and England have concluded that births at home with midwives have fewer complications than hospitals. Critics suggest healthcare systems that are unique to the United States could put homebirthing women at greater risk.

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Data on Homebirth with Midwives in the United States is Now Available

A study published in the Jan-Feb 2014 Journal of Midwifery and Women’s Health included 16,924 women who planned to birth at home between November of 2004 and December of 2009. The mothers volunteered for the study and midwives entered data, starting with early prenatal visits. The Midwives Alliance of North America (MANA) developed the web-based statistics project.

Are you expecting your first baby? First-timers made up 22% of the sample. And although blacks, Latinas, Asians and Native Americans participated, the majority of mothers in the project were white, college educated, and resided in the Western United States. They were of normal weight and their averaged age was 30.

Almost two-thirds of the women paid for their birth out-of-pocket instead of using insurance because homebirth was not covered, the midwife didn’t take insurance, or the family was uninsured.

Can You Birth at Home if You Have Pregnancy Complications?

According to their midwives, 168 of the women developed some type of complication; 74 saw a doctor at least once and 47 had at least three visits. Of all those planning homebirths, 89% succeeded in delivering at home. Transfers to the hospital, mostly for failure to progress, occurred in 11% of cases.

The overall cesarean rate for the study group was only 5.4%. In contrast, the Centers for Disease Control reports that the overall rate of cesarean births in the United States in 2012 was 32.8%.

Vaginal Birth After Cesarean and Breeches Can Happen at Home

Have you had a previous cesarean delivery? Eleven hundred women in the study did too. Eighty seven percent succeeded in a vaginal birth, 94% of those took place at home.

Your baby has a 95% chance of turning head down by about 34 weeks gestation, but breech presentation leads to a cesarean section in most U.S. hospitals. There were 222 breech babies in the planned homebirth study. A vaginal delivery was the outcome in 127 of cases; 92% of those were born at home.

Count on Your Midwife to Offer Support

You may want to avoid an episiotomy – that’s a surgical cut to enlarge the vaginal opening during delivery. Approximately 30% of hospital deliveries include this procedure. Among homebirth midwives, the rate was only 1.4%. Nearly half the women birthing at home had no lacerations and 40% had minor tears. Only 4.8% of women in the study needed stitches.

You might expect that breastfeeding will get off to a good start if you birth at home. Of the study’s home-born babies, 97% were still breastfed at six weeks of age, 86% exclusively.

Problems Sometimes Occur After Your Baby is Born

Among the cases studied, 177 went to the hospital following a home delivery. Reasons included excessive blood loss, laceration repairs, rapid births in which the parents called an ambulance, mothers who were unable to urinate after giving birth, and those whose temperature, pulse or blood pressure were not normal.

Is homebirth really safe for your baby?

One percent of newborns in the study got a ride to the hospital because of breathing problems or birth defects. Regardless of where they were born, 2.8% were admitted to a neonatal intensive care unit within the first six weeks of life.

Stillbirths occurred in the study group at the rate of 1.30 per 1,000 deliveries. To put that in perspective, 2005 data from the National Vital Statistics Report revealed the U.S. averaged 6.2 stillbirths per 1000 deliveries.

The death rate for the homebirth population dropped to 0.85 per 1,000 deliveries when excluding women with known risk factors.

A Variety of Midwives Were Registered in the Project

When you recruit a midwife to attend your homebirth, she will probably inform you of her designation. Nearly one-third of participating midwives in the MANA study were either Certified Professional Midwives (CPMs), Licensed Midwives (LMs) or Licensed Direct-Entry Midwives.

These midwives completed a course of study, apprenticeship, clinical skills evaluation and a comprehensive exam. State laws may regulate their scope of practice.

Forty-four Certified Nurse Midwives (CNMs) or Certified Midwives (CMs) also contributed data to the study. CNMs and CMs qualify for midwifery education after earning a bachelor’s degree in nursing or another field.

Sixteen of the midwives who registered in the database were both CPM and CNM, and 52 contributing midwives were neither. The latter group included naturopaths or unlicensed direct-entry midwives.

The Study Measured Over 200 Variables

Technical assistants called “Data Doulas” provide supported and facilitated the collection of data. They collected client and family health history information, including socio-economic status, events during care, procedures and outcomes up until six weeks after birth.

Your next question might be whether the study’s results are reliable. What if some midwives chose to report only positive outcomes? The researchers devised a system of pre-registration and logging of early information, before outcomes were known. In addition, a strict pre- and post -submission review process ensured the accuracy of the data.

Is Homebirth Right for You?

Information gleaned from this project offers reassurances for you and other moms who may want to plan a homebirth. Additionally, the data offers far-reaching and unique opportunities for further research on normal birth and midwife-led outcomes. The study shows the safety of planned homebirth.

When it comes to midwife-led care, less technology truly appears to be more effective for many women.

Author Spotlight

Mary Earhart

A graduate of CSU Domingues Hills BSN program, Mary Earhart is a practicing Licensed Midwife and Public Health Nurse in Southern California. She has worked in hospitals, alternative prison programs, and developed an award-winning ...